Concerns, satisfaction, and retention of Canadian community health nurses

This study of Canadian community health nurses (N = 1,044) compared the work-related concerns, job satisfaction, and factors influencing the retention of public health, home care, and community care access center (CCAC) nurses. Community health nurses identified similar work-related issues as being of greatest concern to them, but there were significant differences among the 3 groups of nurses in the magnitude of these concerns. There were also significant differences among the 3 groups for satisfaction with their jobs and their immediate supervisors, with CCAC nurses being the least satisfied except for the greater dissatisfaction of home care nurses with their pay and benefits. For the retention factors, the differences were primarily in the areas of job features and supportive work relationships. There are both similarities and differences among public health, home care, and CCAC nurses. Initiatives to address community health nurses' concerns, improve their job satisfaction, and increase their retention will require interventions tailored to the specific community health care setting.     

Job control,work-family balance and nurses’ intention to leave their profession and organization: A comparative cross-sectional survey

BackgroundThe shortage of nurses is a problem in many countries. In Japan, the distribution of nurses across different care settings is uneven: the shortage of nurses in home healthcare and nursing homes is more serious than in hospitals. Earlier research has identified numerous factors affecting nurses’ intention to leave work (e.g., job control, family-related variables, work-family conflict); however, these factors’ levels and effect size may vary between nurses in hospitals, home healthcare, and nursing homes.ObjectivesThis study measured job control, family-related variables, and work-family conflict among nurses in hospitals, home healthcare, and nursing homes, and compared these variables’ levels and effect size on nurses’ intention to leave their organization or profession between these care settings.DesignThe research design was cross-sectional.MethodsParticipating nurses from hospitals, home healthcare facilities, and nursing homes self-administered an anonymous questionnaire survey; nurses were recruited from the Kyushu district of Japan. Nurses from nine hospitals, 86 home healthcare offices, and 107 nursing homes participated. We measured nurses’ intention to leave nursing or their organization, perceived job control, family variables and work-family conflict. We analyzed 1461 participants (response rate: 81.7%).ResultsThe level of job control, family variables, and work-family conflict affecting nurses varied between hospitals, home healthcare, and nursing homes; additionally, these variables’ effect on nurses’ intention to leave their organization or profession varied between these care settings. Work-family conflict, family variables, and job control most strongly predicted nurses’ intention to leave their organization or profession in hospitals, home healthcare, and nursing homes, respectively.ConclusionsInterventions aiming to increase nurse retention should distinguish between care settings. Regarding hospitals, reducing nurses’ work-family conflict will increase nurse retention. Regarding home healthcare, allowing nurses to fulfill family responsibilities will increase nurse retention. Regarding nursing home nurses, increasing nurses’ job control will increase nurse retention.     

Retention of nurses in the primary and community care workforce after the age of 50 years: database analysis and literature review

Title.  Retention of nurses in the primary and community care workforce after theage of 50 years: database analysis and literature review.
Aim.  This paper is a report of a study conducted to explore strategies for retaining nurses and their implications for the primary and community care nursing workforce.
Background.  An ageing nursing workforce has forced the need for recruitment and retention of nurses to be an important feature of workforce planning in many countries. However, whilst there is a growing awareness of the factors that influence the retention of nurses within secondary care services, little is known about those that influence retention of nurses in primary and community care. Little is known about the age profile of such nurses or the impact of the ageing nursing workforce on individual nursing specialities in the England.
Methods.  Nursing databases were analysed to explore the impact of age on nursing specialities in primary and community care. The nurse retention literature was reviewed from 1995 to 2006.
Findings.  Workforce statistics reveal that primary and community care nurses have a higher age profile than the National Health Service nursing workforce as a whole. However, there are important gaps in the literature in relation to the factors influencing retention of older primary and community care nurses. Specific factors exist for older nurses within primary care that are unique. Implications for their retention are suggested.
Conclusion.  Particular attention needs to be paid to factors influencing retention of older nurses in primary and community care. These factors need to be incorporated into local and national policy planning and development.     

Caring in residential aged‐care. Qualitative findings from an e‐cohort sub‐study

Aim. The aim of this e‐cohort sub‐study was to explore and describe nurses’ understandings of ‘caring’ in residential aged‐care. Background. The quality of the work environment is an important issue for recruitment, retention and workforce planning. Knowledge about the people in and the place that is the residential aged‐care facility may assist with the problems surrounding the recruitment and retention of nurses in the workforce. Design. Qualitative electronic cohort sub‐study. Methods. This paper presents the qualitative research findings from an electronic cohort sub‐study of 58 registered and enrolled nurses working in the residential aged‐care sector in 2007. Data were collected through an open ended question and a qualitative content analysis was used to generate the core categories. Results. The concept of caring was grounded in and constrained by, the everyday reality of the nurses in the study. Organisational imperatives for the completion of documentation necessary for accreditation and funding combined with under‐staffing restricted the time available for caring practices. Some nurses represented residential care faculties as devoid of care, others as a place where the resident was central to their work and care. The staff perceived of themselves as an ageing workforce in need of rejuvenation and resourcing. Conclusion. The concept of caring is manifest in nurses’ language as they describe their workplace, the residents, themselves and the structures that impact on what they do. Good caring manifests itself when the residents are central to the business of the aged care facility. However, nurses in this study describe a range of restrictive factors impeding caring practices and diminishing workforce morale and motivation to create environments that can truly be called a ‘home‐away‐from‐home’ and one that all people would find acceptable. Relevance to clinical practice. These findings have implications for aged‐care sector recruitment, retention and workforce planning within residential aged‐care facilities.     

The importance of work environment: evidence-based strategies for enhancing nurse retention

As the nation faces a growing nursing shortage, it is imperative that home care leaders implement evidence-based strategies to improve nurse recruitment and retention. Previous research indicates that characteristics of the work environment that support nursing practice enhance nurses' job satisfaction and reduce turnover. Yet, there is little evidence to assist in prioritizing initiatives to improve the work environment of nurses. In this nationwide survey, home care nurses were asked to rate the importance of specific agency work environment traits, as listed on the Nursing Work Index-Revised, in supporting their home care practice. The 10 agency traits rated as most important are presented, and evidence-based recommendations for creating a culture of nurse retention are discussed.     

‘I feel like a salesperson’: the effect of multiple‐source care funding on the experiences and views of nursing home nurses in England

The difficulties faced in the recruitment and retention of nursing staff in nursing homes for older people are an international challenge. It is therefore essential that the causes of nurses’ reluctance to work in these settings are determined. This paper considers the influence that multiple‐source care funding issues have on nursing home nurses’ experiences and views regarding the practice and appeal of the role. The methodology for this study was hermeneutic phenomenology. Thirteen nurses from seven nursing homes in the North East of England were interviewed in a sequence of up to five interviews and data were analysed using a literary analysis method. Findings indicate that participants are uncomfortable with the business aspects that funding issues bring to their role. The primary difficulties faced are: tensions between care issues and funding issues; challenges associated with ‘selling beds’; and coping with self‐funding residents’ changing expectations of care. The findings of the study suggest that multiple‐source care funding systems that operate in nursing homes for older people pose challenges to nursing home nurses. Some of these challenges may impact on their recruitment and retention.     

Easing the impact of the family caregiver's role

This article describes problems facing family caregivers of elderly, ill, or disabled people. The physical and emotional impact of caregiving is explored, and the concept of role fatigue is discussed to assist nurses in understanding caregivers' problems and needs. Motivational factors for becoming a caregiver and community sources of support are addressed. Rehabilitation nurses are challenged both to accept the responsibility of identifying caregiver role problems, and to help caregivers obtain assistance that will enable them to continue family members' care in a home environment.     

Contribution of professional nurses of ambulatory nursing services to home nursing care

The meaning and understanding of home care is a leading factor in health care both nationally and internationally. The implementation of the law on care insurance in Germany demonstrates the understanding of home care and shows changes in health care policy. This new context of health care delivery influences the nursing profession. New challenges arise and changes in nursing perspectives are necessary. The presented study focuses on the contribution of nurses in home care situations. Its aim is to illuminate and to understand the perspective of home care nurses. Grounded Theory approach is used. Altogether, nine participants are interviewed. The results show that nurses aim at keeping care recipients in a home care situation as long as possible. In order to achieve this, the contribution of nurses are not just limited to rediscountable benefits. Voluntary interventions such as managing housework and emotional support for care recipients are also being rendered. However, these actions depend on several factors, such as the relationship between the nurse and the care recipient, the home care situation or the professional attitude of the nurse. In this context, nurses have to develop strategies to deal with these various tasks. The discussion emphasizes the legislative framework of home care in Germany as well as factors that influenced the study.     

Influencing factors of community mental health nurses caring for people with schizophrenia in Taiwan

The purpose of this study was to explore the influencing factors in the substantive theory of home care for people with schizophrenia in Taiwan. The grounded theory of Strauss and Corbin approach was used. Semi-structured one-to-one in-depth interviews were utilized to collect data. Constant comparative analysis continued during the open, axial and selective coding processes until data saturation occurred. Participants were selected using theoretical sampling, and the final sample in this study consisted of a total of 29 community nurses (18 public health nurses and 11 home health nurses) who provided community mental health home-visiting services. The public health nurses and home health nurses both conducted a total of 16 (eight carers and eight clients) home visits. Four categories and 12 subcategories of influencing factors were identified; these factors have both positive and negative effects on nursing roles and the functions of public health nurses in the mental health home-visiting service in Taiwan. The influencing factors identified support the importance of home care services.     

Family caregiving at home

PPS has demanded that we teach caregivers to assist while receiving home care and upon discharge. This article focuses on what home care nurses need to know to adequately prepare families for the caregiving experience. Specific strategies for efficiently facilitating caregiver support including assessment, specific problems, and resource and referral suggestions are addressed.     

The ten commandments of caring for patients after open heart surgery

Ten major issues must be addressed when providing home care services for patients recovering from open heart surgery. Filled with tips for patients and nurses, the "10 Commandments" present a creative way for nurses to teach patients as well as use this framework in individual care plans and agency clinical paths.     

Nursing Career Coach: The Difference

Nursing retention is critical for health care organization success. Reasons for nurses exiting their current organizations include access to professional growth explicitly aligned with the individual nurse’s purpose. One health care system sought to address this need with the creation of the nurse career coach (NCC) to support nurses in exploring roles that align with their individual passion and purpose. Through the coaching process, professional growth, nurse retention, and empowerment of nurses have been experienced as a result. Our evaluation revealed a 96% retention rate. The article details NCC design, implementation, and evaluation, including factors describing spread, sustainability, and scale.     

What makes a good intensive care unit: a nursing perspective.

With the high prevalence of nursing shortages and low staff retention rates in many Australian intensive care units (ICUs), we aimed to determine what factors were important to nurses working in an ICU. Of all the nursing specialties in New South Wales, intensive care was reported to have had the fifth highest vacancy rate from June 2000-January 2001. A questionnaire was distributed to 36 nurses in a major metropolitan ICU. The response rate was 32 (89 per cent). The ICU has had high staff retention rates and low vacancy rates for a number of years. We were interested to document what factors made this unit a popular one to work in. Factors that were of greatest importance to most nurses were those that dealt with nursing unit management and medical staff. Other factors that rated highly included the ability to self-roster, some aspects of working relationships and having an active role in patient care issues. The survey informed us that nurses at this study site were mostly satisfied with these aspects. Previous studies have demonstrated a strong correlation between job satisfaction and turnover rates amongst nurses. The results of this study highlight the importance of good nursing management and various aspects of the nursing role in attaining job satisfaction in the workplace. These key factors play an important role in achieving high staff retention and low vacancy rates.     

Collaborative and supervisory relationships between attending physicians and advanced practice nurses in long-term care facilities

Recent years have seen an increased interest and use of advanced practice nurses (APN) in long-term care. Models of best practices of supervision and collaboration have been promulgated by many organizations, but none have specifically addressed how these interactions should occur in the nursing home setting. In order to better define the role of the attending physician and APN to provide optimal resident care, American Medical Directors Association formed a work group to address collaborative and supervisory relationships in long-term care facilities.     

Home care nursing: professional and political issues

Concern for quality, cost, and access dominate the health care system in the eighties. State and national actions, demographic changes, and technological advances are converging to create many changes in the home care delivery system. Knowledgeable nurses can influence the evolution of home care services to assure that patients receive appropriate acute and long term home care services. Concern for quality care, changing patient needs, and availability of care are the major issues facing home care nursing in the eighties, and will continue to be into the nineties. Reimbursement policies of third party payers, medicare/medicaid regulations, state licensing, employer benefit programs, state health programs, home health care providers, professional/trade associations, and consumer advocacy groups are some of the key forces reshaping the practice of home health nurses. Knowledge of these factors will enable nurses to influence effectively the design of institutional and governmental policies which affect the care nurses deliver to patients at home.     

Home healthcare nurse recruitment and retention: tips for retaining nurses: one state's experience

During March 2006, a series of statewide conferences was held to discuss home care outcomes, with a special emphasis on strategies for retaining home care nurses. Administrators and owners of home care agencies in one state with high staff retention and a low rate of turnover participated in four panel discussions to share best practices. The discussions were sponsored by TMF Health Quality Institute, the Quality Improvement Organization (QIO). In addition to practitioner panels, a review of the home care research literature on recruitment and retention was presented. This article is derived from the combined evidence shared during those meetings. The three most common strategies for retaining nursing staff were the use of case management or primary nursing, management participation in direct patient care, and open lines of communication.     

Stress in hospice at home nurses: a qualitative study of their experiences of their work and wellbeing

The literature has evaluated studies of hospice nurses and stress but very few studies have focused on community hospice nurses. This study explored hospice at home nurses' experiences of caring for palliative and dying patients. Hospice at home nurses working in the community across North West Wales were interviewed and a grounded theory approach was used to categorise the data into the following themes: job satisfaction, stressors, coping strategies, and support. Recommendations arising from the study include encouraging the use of clinical supervision, attendance at multidisciplinary meetings, and the provision of stress-awareness training, and raising awareness of the role of hospice at home nurses in primary care. Implementation of these recommendations might be beneficial for staff wellbeing. Further work would identify whether such recommendations can help to prevent sickness and promote staff retention.     

Home care nursing in Japan: a challenge for providing good care at home

Home care in Japan has developed over the past 30 years. Nurses have taken leadership in promoting home care and at the same time have expanded their roles. The roles of Japanese nurses in the field of home care are presented in the context of the historical perspective and view for the future. Home care nurses have performed care management for their community as well as for individual older clients living in their community. Currently, nurses work as high-tech and personal care providers and are developing a new role in health care enterprises. The number of nurses working as clinical nurse specialists will increase consistently with the rapid increase of master's programs. In the future, nurses should take a lead in developing health policy. The purpose of the article is to describe the current situation of home care clients and home care nursing in Japan. In addition, four issues of home care in Japan are described related to home care for older persons, high-tech home care, terminal care, and home care for psychiatric patients.     

基于老年视角的社区护士主导居家养老影响因素的质性研究

目的：通过老年人的视角来探讨社区护士主导居家养老服务的影响因素,为构建以社区护士为主导的居家养老服务体系提供参考。方法应用质性研究的现象学方法,对15名社区老年人进行面对面半结构化访谈,采用Colaizzi主题分析法对获得的资料进行分析。结果从老年人的视角提炼出5个主要影响因素：人力资源配比不均衡,老人经济条件不足,社区护士待遇低,社区护士养老知识技能和综合素质欠缺,社区护士的社会价值降低。结论大部分老年人对以社区护士为主导的居家养老接受度不高,社区护士主导居家养老的发展需要国家政策和资金支持;社区护士应加强各项养老知识技能的培训和提高自身的综合素质,同时政府和社区应加强对社区护理的宣传,以提高居民的信任。